This protocol is a descriptive, cross-sectional, nationally representative study to investigate nonphysician practitioners' (NPs and PAs) perceptions of ethical issues associated with primary care practice. NPs in primary care have expressed ethical conflicts in clinical practice centering on issues of justice, rights, responsibility, nonmaleficence, and beneficence. Other ethical conflicts identified for NPs include arrangements with managed care organizations, professional accountability, pressure to see an increasing volume of patients, and bonus and billing practices to lower costs. With the projected trends for NPs and PAs substantially increasing, knowledge of factors that influence ethical practice will be relevant in shaping the future role of the NP and PA for the provision of quality cost-effective health care. Additionally, as part of the methodological purpose of the study, to evaluate the effectiveness of monetary incentives to increase response rates to a mailed self-administered questionnaire, subjects will be randomly assigned to one of three incentive groups. Data will be analyzed using descriptive statistics and measures of central tendency (frequencies, mean, standard deviation) as well as bivariate correlations. Multivariate regression will be utilized to determine factors that predict ethical conflict in practice and perceived delivery of quality care. Surveys were mailed, beginning in November 2002 to 3900 Nonphysician clinicians in the U.S. Data on ethical conflicts and impact on practice are currently being analyzed. Response was highest in the group randomized to a $5 cash incentive, and a manuscript on the randomized incentives has been submitted.